5183.0: Wednesday, November 15, 2000 - 3:15 PM

Abstract #5638

The risk of end-stage renal disease (ESRD) among blacks and whites and the management of diabetes mellitus by community physicians

William McClellan, MD, Robert D. Langston, MSPH, and W. Dana Flanders, MD. Georgia Medical Care Foundation, 57 Executive Park South Suite 200, Atlanta, GA 30329

Background. African Americans are at increased risk of ESRD compared to whites. We examined the association between variations in care of diabetes among different race groups and the risk of ESRD due to diabetes (DM-ESRD). Methods. Patients (n=1643) with DM-ESRD in 1995 and 1996 were identified and assigned to the county of residence at first treatment. Medicare Part B data for individuals ages >64 years with one in-patient or two outpatient claims for diabetes mellitus were used to calculate a race-sex-county specific testing rate of glycosylated hemoglobin (A1C) and quantitative urine protein (UA). Poisson regression models tested the association between patient characteristics, A1C, UA and risk of DM-ESRD. Results. Substantial county-to-county variation testing for A1C and UA were found. DM-ESRD was higher among blacks (RR=3.69) and blacks were less likely to be tested for A1C (RR=0.77) and UA (RR=0.62). The risk of DM-ESRD increased for persons residing in counties with low rates of A1C (P=0.04) and UA (p=0.007) testing. After controlling for age, sex, and county testing rates, race remained strongly associated (p<0.0001) with risk of DM-ESRD. Conclusions. We found an inverse association between better care of diabetes mellitus and the risk of DM-ESRD. After controlling for county-care, blacks remained at higher risk of DM-ESRD.

Learning Objectives: At the conclusion of the session, the participant will be able to: 1. Assess use of Medicare files for diabetes outcome 2. Discuss variation by county in testing for HbA1c and urine protein and how it relates to ESRD

Keywords: Diabetes,

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

The 128th Annual Meeting of APHA